A discourse analysis of social inequities, gender, and stigma in tuberculosis policies of seven countries from Africa, Asia, Europe and South America

Background: Interventions tackling the social aspects of tuberculosis (TB) are widely suggested, yet we miss insights into how policies incorporate these. The language and framing of policies to address TB can lend important insights into how these social drivers are perceived, problematized, and responded to.

Objective: To understand how discourses in current TB policies frame social dimensions of TB, especially concepts of social inequity, gender, and stigma.

Methods: We conducted a comparative critical discourse analysis of twenty-one publicly available TB-related policies from Belarus, Brazil, Indonesia, Mozambique, Netherlands, Portugal, and Romania, countries with diverse epidemiological, geographical and sociopolitical contexts. Documents were sourced from public websites from May – September 2024. The Bacchi approach was used to analyze policy framings of social inequities, gender, and stigma.

Result: While policies from Brazil and Indonesia showed greater attention to social inequities, gender, and stigma, and were more explicitly reflective of an equity-oriented and people-centered approach, overall, a dominant biomedical perspective was observed that individualizes responsibility for cure. This tends to disregard issues of social inequity, obscures gender relationships and the multiple dimensions of stigma. At the same time, allocation of individual as well as structural responsibility for TB risk and outcomes co-existed.

Conclusions: Explicit and implicit discourses about TB within health-related policies can influence the nature of attention given to the social dimensions of TB and can shape corresponding responses to the disease. We recommend a participative policy process that includes a broader set of actors to ensure documents are responsive to social realities.